Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 282N00000X | General Acute Care Hospital | | 22 | IDAHO | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 000010004580 | OTHER | IDAHO | REGENCE BLUE SHIELD 1500 |
| 2 | 0354783 | MEDICAID | MONTANA | |
| 3 | 000010004581 | OTHER | IDAHO | REGENCE BLUE SHIELD 1500 |
| 4 | 130024 | MEDICARE OSCAR/CERTIFICATION | IDAHO | |
| 5 | 000010004583 | OTHER | IDAHO | REGENCE BLUE SHIELD UB92 |
| 6 | 3300423 | MEDICAID | WASHINGTON | |
| 7 | 7106958 | MEDICAID | WASHINGTON | |
| 8 | 8K388 | OTHER | IDAHO | BLUE CROSS 1500 |
| 9 | 00067 | OTHER | IDAHO | BLUE CROSS UB92 |
| 10 | 0146625 | OTHER | WASHINGTON | DEPT OF LABOR 1500 |
| 11 | 000010004582 | OTHER | IDAHO | REGENCE BLUE SHIELD |
| 12 | 7027337 | MEDICAID | WASHINGTON | |
| 13 | 0027647 | OTHER | WASHINGTON | DEPT OF LABOR UB92 |
| 14 | H5337 | MEDICARE ID-TYPE UNSPECIFIED | IDAHO | RAILROAD 1500 |
| 15 | 0410280 | MEDICAID | MONTANA | |
| 16 | 002406400 | MEDICAID | IDAHO | |
| 17 | 1254607 | MEDICARE ID-TYPE UNSPECIFIED | IDAHO | MENTAL HEALTH |
| 18 | 1254606 | MEDICARE ID-TYPE UNSPECIFIED | IDAHO | PART B 1500 MEDICARE |
| 19 | 002274000 | MEDICAID | IDAHO | |
